Int J Ayu Pharm Chem

Greentree Group Publishers

Received 25/07/19 Accepted 20/08/19 Published 10/09/19

________________________________________________________________

Aditi and Raut 2019 Greentree Group Publishers© IJAPC Int J Ayu Pharm Chem 2019 Vol. 11Issue 2 www.ijapc.com 465 [e ISSN 2350-0204]

Int J Ayu Pharm Chem REVIEW ARTICLE www.ijapc.com

e-ISSN 2350-0204

ABSTRACT

Mutraghata is one of the complicated and less understood term in Ayurvedic classics. Earlier,

various authors have related various types of Mutraghata with various uropathies. Considering

that into mind, this research work focuses on, “how and up to what extent, clinical conditions

under Mutraghata are related to Bladder outlet obstruction (BOO)”. Bladder outlet obstruction

(BOO) is a generic term for all forms of obstruction to the bladder outlet including benign

prostatic obstruction (BPO). It is a urodynamic concept based on the combination of low flow

rate, low voided volumes and high voiding pressure. For that, we have collected classical data

mainly from Sushruta Samhita, Charaka Samhita, Ashtanga Hridaya and their commentaries

by Dalhana, Chakrapani and Arundatta respectively. As per modern texts, details on Bladder

outlet obstruction (BOO) have explained first. Only on the basis of clinical features and

pathogenesis mentioned in our classical texts, correlation of clinical entities under Mutraghata

with Bladder outlet obstruction (BOO) has established later.This research work concludes that

clinical manifestations of Mutraghata are mainly confined to lower urinary tract system

(LUTS).Clinical entities in Mutraghata are clinical manifestations of Bladder outlet

obstruction due to mechanical blockage at the base of the bladder or malfunction of vesico-

ureteric coordination during act of micturition or functional failure due to neuro-deficit or

muscular/detrusor instability. It stops or reduces urinary flow into urethra. Clinical entities

under Mutraghata xcept Mutrateeta and Mutrashukra are correlated with Bladder outlet

obstruction (BOO).

KEYWORDS

Mutraghata, Bladder outlet obstruction, BOO.

A Critical Review of Mutraghata with Special Reference to

Bladder Outlet Obstruction (BOO)

S Y Raut1 and Aditi2*

1-2Department of Shalyatantra, Government Ayurveda College and Hospital, Nagpur, MS, India

http://www.ijapc.com/

________________________________________________________________

Aditi and Raut 2019 Greentree Group Publishers© IJAPC Int J Ayu Pharm Chem 2019 Vol. 11 Issue 2 www.ijapc.com 466 [e ISSN 2350-0204]

INTRODUCTION

Mutrarogas (urinary disorders) were

vividly described in the literature of Vedic

period; where one can find a wide range of

references related to various uropathies.

Vagbhata has classified the Mutraroga into

two categories viz. Mutra-atipravrittija and

Mutra-apravrittija1. The disease Prameha

falls under the first group whereas Ashmari,

Mutrakricchra and Mutraghata into the

other. Broadly speaking, metabolic diseases

marked by polyuria can be grouped under

the caption of Prameha while diseases of

bladder and urethra marked by some

obstruction either mechanical or functional,

resulting into partial or complete retention

of urine, oligouria or anuria fall under the

heading of Mutraghata. The clinical

manifestations of bothMutrakricchra and

Mutraghata seem to be superimposed on

each other but Dalhana, Chakrapani and

Vijayarakshita have demarcated the

difference between two. The difference is

based on the severity of Vibandha or

Avarodha (obstruction) which is more

noticeable in Mutraghata2.

Dalhana quoted that “Mutraghaten

mutravarodhah” i.e. obstruction to the flow

of urine can be considered as Mutraghata.

He further quoted that some experts refer

the term “Dushti” instead of “Aghata3”

because a few types of Mutraghata like

Mutrashukra, Vidvighata, Ushnavata and

Mutraukasada do not present the symptoms

of urinary obstruction.

Chakrapani commented on Mutraghata as-

“Mutraghatenmutramshoshyatepratihanya

teva” i.e. a condition characterized by

drying up or retention of urine, which can

be mechanical or functional4.

Sushruta and Vagbhata have mentioned 12

types5 of Mutraghata while Charaka has

mentioned its 13 types6.

Bladder outlet obstruction (BOO) is a

generic term for all forms of obstruction to

the bladder outlet including benign

prostatic obstruction (BPO). It is a

urodynamic concept based on the

combination of low flow rate, low voided

volumes and high voiding pressure.

Urodynamically proven BOO may result

from benign prostatic hyperplasia (BPH),

bladder neck stenosis, carcinoma prostate,

functional obstruction due to neuropathic

conditions7. Other causes include bladder

tumour, pelvic tumour, urethral stricture,

urethral spasm, cystocele,pelvic floor

dysfunction and detrusor muscle instability.

With the increasing age the chances of

getting affected by these diseases increases

gently. The resulting obstruction frequently

produces lower urinary tract symptoms

(LUTS).

LUTS8 can be described as voiding

(obstructive) and storage (irritative)


________________________________________________________________


symptoms. Voiding symptoms are

hesitancy (worsened if the bladder is very

full), poor flow (unimproved by straining),

intermittent stream, dribbling (including

after micturition), sensation of poor bladder

emptying and episodes of near retention.

AIMS AND OBJECTIVES

Aim of this study is to define Mutraghata

and clinical entities described under it in

context of Bladder Outlet Obstruction

(BOO) as per today’s science of urology.

Objective of the study is to define various

technical terms related to Mutraghata and

BOO.

MATERIALS AND METHOD

Collection of data was done mainly from

SushrutaSamhita, CharakaSamhita,

AshtangaHridaya and their commentaries

by Dalhana, Chakrapani and Arundatta

respectively. Along with it modern urology

books, websites and research articles have

also been searched to elaborate the work.

Modern review

Bladder outlet obstruction is a blockage to

or below the level of base of the bladder.

Aetiology9

Urodynamically proven bladder outlet

obstruction may result from:

1. Benign prostatic hyperplasia (BPH)

2. Bladder neck stenosis

3. Bladder neck hypertrophy

4. Prostate cancer

5. Urethral stricture

6. Functional obstructions due to

neuropathic conditions (Neurogenic

bladder)

The primary effect of BOO on the bladder

are as follows:

1. Urinary flow rates decrease- (for a

voided volume more than 200ml) A peak

flow rate of more than 15 ml/s is normal,

between 10 and 15 ml/s is equivocal and

less than 10 ml/s is low.

2. Voiding pressure increase-Pressure

more than 80 cmH2O are high, pressure

between 60 and 80 cmH2O are equivocal

and pressure less than 60 cmH2O are

normal.

Patients affected with BOO in long term

may appear with features like:

1. The bladder may become unable to

maintain its normal functions. Efficiency of

detrusor contraction decreases and volume

of residual urine develops progressively.

2. During filling phase, the bladder may

become irritable. There may be decrease in

functional capacity of bladder. It can be due

to detrusor over activity.

Clinical features

Lower urinary tract symptoms (LUTS)are a

distinct phenotype of group of disorders

affecting the prostate and bladder that share

a common clinical


________________________________________________________________


manifestation.LUTS(Lower urinary tract

symptoms) can be described as:

Voiding (Obstructive) symptoms:Hesitancy

(worsened if the bladder is very full), poor

flow (unimproved by straining),

intermittent stream, dribbling (including

after micturition), sensation of poor bladder

emptying, Episodes of near retention.

Storage (Irritative) symptoms:Frequency,

nocturia, urgency, urge incontinence,

enuresis.

Depending on the severity of BOO, it may

also present with infections (UTI), retention

and other adverse events.

Complications10

They are as follows:

1. Acute retention: Postponement of

micturition is a common cause;

overindulging in beer and confinement to

bed, on account of intercurrent illness or

operation are other causes.

2. Chronic retention:In patients having

residual urine more than 250 ml, the tension

in the bladder wall increases. The increased

tension in the bladder results in functional

obstruction of the upper urinary tract. It can

also cause bilateral hydronephrosis leading

to upper urinary tract infection and renal

impairment. Such patients may present with

outflow enuresis, incontinence and renal

insufficiency.

3. Impaired bladder emptying:It can lead

to urinary infections and development of

calculi.

4. Haematuria.

5. Pain due to urinary retention.

Ayurvedic review

1. Mutragranthi11/Raktagranthi12

Manifestation of small, round and

immovable tumor(vritta-alpa-sthira) in the

bladder which leads to obstruction to the

flow of urine (Aabhayantarebasti-

mukhemutra-marga-nirodhanah).Sushruta

has not mentioned the Dosha involved in

Mutragranthi but Dalhana in his

commentary believes Pitta Dosha

involvement for the same. As per Charka,

three DoshasRakta, Vata and Kapha are

causative factors (Rakta-vata-kaphat-

dushtam12). It also causes continuous

pain(Vedanavaan), difficulty and pain

during micturition (Kricchrena-srijet-

mutram) and symptoms similar to that of

urinary calculus(Ashmari-sama-shoolam)

In CharakaSiddhisthana,it is stated that

Rakta and Vata both are vitiated in

Mutragranthi. Therefore it can also be

concluded that if in Mutraghranthi, there is

an association of Rakta, the clinical features

would be similar to Carcinoma prostate as

its main feature is Haematuria. Vitiation of

Vata along with Kapha will lead to

symptoms like BPH. Carcinoma prostate


________________________________________________________________


and BPH both obstruct bladder outlet

leading to BOO.

2. Ashtheela13

Aggravated Vata gets localized between the

passage of feces (rectum) and urinary

bladder and produces a hard

tumor/swelling(Achala-unnata-granthi)

like a cobbler’s stone. (Shakrita-margasya

baste cha ashthila-baddhanamgranthi),

which leads to retention of urine, feces and

flatus (Vit-mutra-anila-sanga),

inflation/blowing/swelling (Adhmaan) and

severe pain in urinary bladder/in suprapubic

region (Vedana-cha-para-bastau)

As Ashtheela is present in between bladder

and rectum, it either could be a pelvic

mass/tumor (cervix, prostate, uterus,

rectum leading to bladder outlet

obstruction) or hard compacted stool in

constipated patients (neurogenic bladder

and bowel dysfunction) leading to urinary

retention and other urological conditions.

3. Mutrotsanga14

Vitiated Vata and abnormality of urinary

outlet (Kha-vaigunya, Chhidra-

vaigunya)causes obstruction in the urine

flow at the level of bladder (Basti), urethra

(Nala) and glans penis/ external urethral

meatus (Mani) that leads to obstructed flow

of urine (Mutramprivrattamsajjet), urine

mixed with blood after straining

(Saraktamvaapravahata),

intermittentmicturition in little quantities

(Sthitvasravetshanaihalpamalpam), pain or

without pain (Sarujamvanirujam)and

dribbling micturition (Vicchinnam). The

residual urine is also responsible for

heaviness of the penis (Guru-shephasa).

These clinical features are alike to that of

“Urethral stricture”. Abnormal narrowing

of urethra causes obstruction to the bladder

outlet leading to BOO.

4. Vatakundalika15

Excessive ingestion ofRukshaAhara(Food

deficient in fulfilling daily requirement of

fat in body), intentionally holding the

natural urge of micturition, defecation etc,

leads to vitiation of Vata that enters in the

bladder and traverses in circular manner. It

leads to obstruction in urinary flow and

severe pain. Affected individual also passes

scanty urine with pain that too slowly.

The condition is very similar to Detrusor

sphincter dyssynergia (DSD) and primary

bladder neck obstruction. DSD is the

urodynamic description of BOO. It occurs

as consequences of neurological pathology

like spinal cord injury or multiple sclerosis,

which disrupts functions of central nervous

system, whichregulates the micturition

reflex. Hence it results into disorientation

ofexternal urethral sphincter muscles and

the detrusor muscle of the bladder.

Normally these two separate muscles act in

synergistically. Here in DSD, urethral


________________________________________________________________


sphincter muscle is in dyssynergia,

contracts along with contractions of

detrusor causing the flow to be interrupted.

Bladder pressure rises as a result of it.

In Primary bladder neck obstruction,

bladder neck fails to open properly during

voiding. It results into increased activity of

striated sphincter or obstruction of urine

flow in the absence of another anatomic

obstruction like muscular dysfunction,

neurological dysfunction or fibrosis.

5. Vatabasti16

Holding micturition urge beyond

physiological capacity of bladder for longer

time (Mutra-vega-dharana) leads to

vitiation of Vayu. It enters the bladder

causing the obstruction to the bladder outlet

(Niruddhanimukhamtasya baste

bastigatoanila). Clinical features are

retention of urine (Mutra-sanga), pain in

hypogastric and loin region (Basti-kukshi-

nipiditah), itching sensation(Kandu).

These features are similar to the conditions

like Detrusor areflexia, motor paralytic

bladder and autonomous bladder. All three

are neurogenic conditions of bladder, where

damage to the sacral cord (S2,S3,S4) or

peripheral nerve injury occurs.

6. Bastikundala17

Excessive running(Druta), excessive

pedestrian walking(Adhva-gamana),

fasting (Langhana), exertion (Ayaasa),

trauma(Abhighata) and compression,

compaction (Prapidana) are the causative

factors for Mutrajathara.By indulging in

above mentioned factors, the bladder is

displaced upwards and become enlarged

and it appears like a gravid uterus (Sva-

sthaanaat-bastiudvritta-sthoola-tishthati-

garbhavata).

Clinical features

includecolic(Shoola),throbbing

pain(Spandana), burning pain(Daaha-arti),

dribbling micturtion (Bindu-bindu-sravati).

When the bladder region is pressed, urine

comes out in jets. (Piditahtusrijetdhara)

Autonomous bladder or detrusor areflexia

can be related to Bastikundala.It has

explained only by Charaka. The clinical

features of it are very similar to that of

Vatabasti explained by Vagbhata. For

instance: Basti-udvritta-sthoola-tishthati-

garbhavata (Large bladder capacity, no

detrusor contractions), Peedita-tu-srijet-

dhara (Crede’smaneuver) and Bindu-

bindu-sravatyapi (Overflow incontinence).

Charaka has also explained involvement of

Pitta and Kapha.

Pitta involvement leads to burning

sensation (Daha), pain (Shoola) and

discoloration of urine. It is similar to

infections (UTI) caused by high residual

urine.

Kapha involvement causes oedema

(Shopha), heaviness (Gaurava)and changes

in nature of urine (unctuous and dense). All


________________________________________________________________


these symptoms can be related to renal

damage caused by hydroureter and

hydronephrosis due to vesico-ureteric

reflex.

7. Mutrajathara18

Holding urge of micturition

(Mutrasyavihatevege)vitiatesApanaVayuw

hich causes pain and distention in abdomen

(Apaanahkupitovaayuudarampurayetbhris

ham).Clinical features areretention of urine

and faeces (Adhah-sroto-nirodhanam).

This distention leads to severe pain in lower

abdomen

(Naabhiadhastaadaadhmanjanayettivrave

danam) andindigestion (Apakti).

It is related to spinal cord lesion leading to

spinal shock. In this, flaccid paralysis is

experienced by the affected individual

below the level of injury. The somatic

reflex activity might be depressed or absent.

The anal and bulbocavernosus reflex

activities typically are absent. Urinary

retention and constipation occurs. This

condition is justified by “Adhah-sroto-

nirodhanam”. Flaccid paralysis leads to

large residual urine in bladder, which is

relatable to “Udaram-poorayet-bhrisham”

and “Naabhe-adhastaad-aadhmaan”.

8. Ushnavata19

Excessive exercise(Ativyayam), excessive

walking(Ati-adhva-gaman) and excessive

wandering (Ati-atapa-

sevana)causesaggravation of

Pitta(Vyayam-adhva-

atapaihpittamprapyaanilaavritam,

bastimedhragudamchaivapradahansravay

etadhah). When Pitta is obstructed by Vata,

it produces symptoms of Ushna-vata liie

yellow coloured urine (Mutramharidram),

hematuria or red coloured urine (Saraktam)

or only blood comes out from urethra

(Raktamevava) and difficulty in urination

(Kricchratpravartate).

The condition could be inflammatory

conditions of bladder and urethra, cystitis,

urethritis, ureteritis or prostatitis. When due

to obstruction, amount of residual urine

remainspersistent in the bladder, it irritates

wall of the bladder leading to inflammation

of the related structures. So it can be a

complication of Bladder outlet obstruction.

9. Mutrauksada20

Passage of non-slimy, thick and yellow-

coloured urine along with burning sensation

are the features of Pittaja variety of

Mutrauksada. When urine is

dried,sediments deposited resembles to

Rochanapowder.InKaphaja variety, when

urine is dried, pale sediments similar to the

powders of conch-shell (ShankhaChurna)

gets deposited. Individual feels pain during

urination and the urine is white in color,

thick and slimy in nature.

The condition is alike to urinary tract

infections (UTI), cystitis, urethritis

orprostatitis. These could manifest as a


________________________________________________________________


complication of BOO because of chronic

high residual urine.

10. Mutrakshaya21

In Dehydrated and fatigued person

(Ruksha-klanta-dehasya), Pitta and Vata

located in the bladder gets aggravated

leading to drying up of urine (Bastisthau-

pitta-marutaukuryaatmutra-sankshayam)

It causes burning micturition(Sadaah),

Painful micturition(Vedanam) and

difficulty in micturition/ urination in small

quantities(Kricchram).

It can be correlated with acute kidney

failure (AKF) which is a complication of

BOO. When the bladder becomes over

distended as a result of BOO, the bladder is

thickened and kinked the terminal ureter as

it traverses it. Hockey stick deformity of

terminal ureters occurs. It also results into

failure of uretero-vesical valves. It

ultimately leads to vesico-ureteric reflux,

bilateral hydroureters and hydronephrosis.

All this leads to destruction of renal papilla

nephrons and parenchyma ultimately

leading to impaired renal failure22.

11. Vidvighata23

Indehydrated and malnourished individuals

(RukshaDurbala), the vitiated Vata along

with faeces enters the urinary passage

producing foul smelling urine because of

urine which is mixed with

faeces(Vaatenudavrittamshakrityada,

mutrasrotahprapadyetavit-

sansrishtamtada).

This condition can be compared with

entero-vesical or recto-vesical fistulas.

However the main etiological factor of

these fistulas are Irritable bowel disease,

colitis, colonic diverticuitis and Crohn’s

disease, there are a few case studies

showing that these fistulas may form after

rectal invasion by carcinoma prostate

occurs in significant number of cases

(10%)24.The condition is definitely rare, but

Vidvighata may manifest, resulting from

carcinoma prostate which is one of the

cause for BOO.

12. Mutrashukra25

Performing coitus in presence of

micturition urge (Prati-

upasthitamutramtumaithunamyoabhinand

ati)causesMutrashukra. Here, seminal fluid

ejected by Vata will either precede or

follow the urine stream and it is ash colored

looks

likeBhasmodaka(Tasyamutrayutamretahsa

hsaasampravartate).

The condition is retrograde ejaculation of

semen into bladder due tovarious causes

such as Congestive prostatitis,patientspass

sticky and cloudy urine because of presence

of semen.

Normally bladder neck muscles tighten to

prevent ejaculate from entering in the

bladder. With retrograde ejaculation,


________________________________________________________________


bladder neck muscle does not tighten

properly. Because of it semen enters into

the bladder and urine becomes white in

color.

13. Mutrateeta26

It is caused by suppression of micturition

urges

(Vegamsandharyamutram).Individual, who

has suppressed the urge of urine for a long

time and then desires to eliminate it, then

the urine does not come out or comes out in

a little quantities(Punahpunah) after

straining, accompanied with mild

pain(Pravahatomanda-rujam). It comes out

in small quantities(Alpamalpam) often.

The condition is altered temporary

neurophysiologic conditions of bladder

where patient tries to pass urine after

holding micturition urge for a long time.

RESULTS AND DISCUSSION: On

the basis of clinical features, organic/ non-

organic lesions in MutravahaSrotasa and

site of obstructions, It has been revealed

that diseases mentioned under title

Mutraghata are closely related to various

conditions leading to Bladder outlet

obstruction. This is summarized in the

table:

Table 1 Table showing Mutraghata types and their correlation with urological conditions under Bladder outlet

Obstruction (BOO)

Sr.N

o.

Types of

Mutraghata

Underlying conditions Relation with Bladder

Outlet Obstruction

(BOO)

1 Mutragranthi Benign prostatic hyperplasia A type of Bladder outlet

obstruction (BOO) Carcinoma prostate

2 Ashtheela Pelvic masses causing compression on adjacent organs. A type of Bladder outlet

obstruction (BOO) Pelvic tumors (cervix, uterus, rectum leading to BOO).

3 Mutrotsanga Urethral stricture A type of Bladder outlet

obstruction (BOO)

4 Vatakundalika Detrusor sphincter dyssynergia A type of Bladder outlet

obstruction (BOO) primary bladder neck obstruction

5 Vatabasti Motor paralytic bladder (neurogenic bladder) A type of Bladder outlet

obstruction (BOO) Autonomous bladder (neurogenic bladder)

Detrusor areflexia

6 Mutrajathara Neurogenic bladder (Spinal shock phase in spinal cord

injury)

A type of Bladder outlet

obstruction.

7 Bastikundala Detrusor areflexia A type of Bladder outlet

obstruction (BOO) Autonomous bladder (a type of neurogenic bladder)

Neurogenic bladder leading to acute retention of urine

8 Ushnavata Inflammatory conditions of bladder and urethra. A complication of

Bladder outlet

obstruction (BOO) Cystitis, urethritis, ureteritis,

Prostatitis

9 Mutrauksada Urinary tract infections A complication of

Bladder outlet

obstruction (BOO) Cystitis, urethritis, prostatitis


________________________________________________________________


10 Mutrakshaya Acute kidney failure (AKF) characterized by anuria A complication of

Bladder outlet

obstruction (BOO)

11 Vidvighata Entero-vesical fistula It can very rarely occur

as a complication of

carcinoma prostate, a

cause for bladder outet

obstruction.

Recto-vesical fistula

12 Mutrashukra Retrograde ejaculation due tovarious causes such as

Congestive prostatitis, patientspass sticky and cloudy

urine because it contains semen.

No relation with

Bladder outlet

obstruction (BOO).

13 Mutrateeta The altered neurophysiologic conditions of bladder where

patient tries to pass urine.

No relation with

Bladder outlet

obstruction (BOO).


________________________________________________________________


CONCLUSION

After reviewing the literature part, it can be

concluded that:

1. Clinical manifestations of Mutraghata

are mostly confined to lower urinary tract

system.

2. Clinical entities in Mutraghata are

clinical manifestations of Bladder outlet

obstruction due to mechanical blockage at

the base of the bladder or malfunction of

vesico-ureteric coordination during act of

micturition or functional failure due to

neuro deficit or muscular/detrusor

instability. It stops or reduces urinary flow.

3. All the types of Mutraghata can be

divided into three major categories on the

basis of clinical features, organic/non-

organic lesions to MutravahaSrotasa and

site of obstruction.

a) Direct correlation with Bladder outlet

obstruction (BOO)

b) Complication of Bladder outlet

obstruction (BOO)

c) No relation with Bladder outlet

obstruction (BOO)

a) First category i.e. direct relation with

bladder outlet obstruction includes

diseases of Mutragranthi, Mutrotsanga,

Ashtheela, Vatakundalika, Vatabasti,

Mutrajatharaand Bastikundala. Because

BOO is mainly caused by BPH, urethral

stricture, carcinoma prostate and

neurogenic bladder respectively.

b) Second category includes Ushnavata,

Mutraukasada, Mutrakshaya and

Vidvighata and they are indirectly related to

BOO. They can occur as complication of

Bladder outlet obstruction (BOO)

because high residual urine in bladder can

lead to UTI, cystitis, urethritis, prostitis and

at last to renal failure. However,

enterovesical fistulas can occur as a

complication of carcinoma prostate and

bladder carcinoma in rare cases.

c) Third category includes

MutrashukraandMutrateeta. They have no

relation with bladder outlet obstruction

(BOO).


________________________________________________________________


REFERENCES

1. BramhanandTripathi,

AshtangaHridayam of Vagbhata, Hindi

Commentary Nirmala, Nidanasthana,

Chapter 9, Verse 40, Delhi: Chaukhambha

Sanskrit Pratisthan, 2015, Page no 493.

2. Sudarshanshashtri, Uttarardha,

MadhavaNidana of Madhavakar, Hindi

commentary Vidyotini,

Mutraghatanidanam, Chapter 31, Verse 1,

Varanasi: ChaukhambaSanskritaSansthan,

2000, Page no 505.

3. JadhavjiTrikamji Acharya,

SushrutaSamhita of Sushruta, Sanskrit

Commentary Nibandhasangraha,

Uttarasthana, Chapter 58, Verse 1,

Varanasi:

ChaukhambaSubharatiPrakashan, 2014,

Page no. 787.

4. Vd.JadhavajiTrikamji Acharya,

CharakSamhita of Agnivesh, Commentary

Ayurved-Dipika, Chikitsasthan, Chapter

26, Verse 44, Varanasi: Chauwkhambha

Sanskrit Sansthan 2000, page no.600.

5. AmbikadattaShastri, SushrutaSamhita of

Sushruta, Commentary

AyurvedTatvaSandipika, Part-2,

Uttarasthana, Chapter 58, Verse 3-4,

Varanasi: Chauwkhambha Sanskrit

Sansthan, 2012, Page no 539.

6. KashinathShashtri and

GorakhnathChaturvedi, CharakaSamhita of

Agnivesh, Hindi Commentary Vidyotini,

Part-2, Siddhisthana, Chapter 9, Verse 25-

26, Varanasi: ChaukhambaBharati

Academy, 2012, Page no. 1057.

7. Bailey and love, The prostate and

seminal vesicles, Chapter-78, Short

practice of surgery, Vol-2, 27th Ed, CRC

press, 2018, Page no. 1459.

8. Bailey and love, Urinary symptoms and

investigations, Chapter-75, Short practice

of surgery, Vol-2, 27th Ed, CRC press,

2018, Page no. 1375.









11. AmbikadattaShastri, SushrutaSamhita

of Sushruta, Commentary







Agnivesha, Hindi Commentary Vidyotini,

Part-2, Siddhisthana, Chapter 9, Verse 41,

Varanasi: ChaukhambaBharati Academy,

2012, Page no. 1061.


________________________________________________________________




























Agnivehsa, Hindi Commentary Vidyotini,

























Uttarasthana, Chapter 58, Verse 17,



22. Olajide OA et al., Sch. J. App. Med.

Sci., 2014; 2(3C):1041-1044.



Agnivehsa, Hindi Commentary Vidyotini,




24. A.C. Buck and G.D. Chisholm,

Rectovesical Fistula Secondary to Prostatic

Carcinoma, AUA Journals, volume issue 6,

June 1979, page 831-832.


________________________________________________________________















Documents

Int J Ayu Pharm Chem